Iron Poisoning — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Severity
   Severity (serum iron / symptoms / ingested dose)? (Five stages: 1) GI (0–6 h, corrosive hematemesis/melena/fluid loss) 2) latent (6–24 h, symptoms ease but early acidosis) 3) acidosis/shock (6–72 h, high-anion-gap metabolic acidosis, coagulopathy, multi-organ) 4) hepatotoxicity (12–96 h, raised transaminases → liver failure) 5) late (2–8 weeks, pyloric/intestinal strictures). Common in childhood accidental ingestion. Diagnosis: serum iron at 4–6 h, abdominal X-ray (radio-opaque tablets), high-anion-gap acidosis, monitor LFTs for 5 days.)
   • Severe (serum iron >500 / shock / acidosis / marked symptoms) → Severe → deferoxamine
   • Mild–moderate (no systemic toxicity) → Mild–moderate · support + WBI
2. [End] Mild–moderate · support + WBI
   No systemic toxicity: fluids to maintain volume; whole-bowel irrigation (PEG) to clear residual tablets (especially with tablets on X-ray / large ingestion >60 mg/kg); activated charcoal is ineffective (unless another toxin is co-ingested); serial serum iron, blood gas, LFTs, vital signs; discharge may be considered if asymptomatic at 6–12 h with serum iron <350 and normal labs. Escalate if it worsens.
3. [End] Severe → deferoxamine
   Deferoxamine indications: serum iron >500 µg/dL, or >350 + symptoms (persistent vomiting/acidosis/tachycardia/hypotension/lethargy/tablets on X-ray), systemic toxicity, high-anion-gap acidosis, shock, organ dysfunction — continuous infusion 15 mg/kg/h (max 35, ≤6 g/day), titrated to clinical recovery (~24 h, may produce 'vin rosé' urine); monitor for hypotension (adds to iron toxicity, needs fluids). Concurrently anti-shock fluids and acidosis correction, PRBC for GI bleeding, NAC for liver injury, whole-bowel irrigation to clear tablets; ICU, toxicology consult.

Source guidelines & references

• Iron poisoning (StatPearls; LITFL; Merck Manual)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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